Home Blood Pressure: Accuracy is Independent of Monitoring Schedules

Long-term morbidity and mortality from hypertension are more closely related to home than to casual office blood pressure levels. There is no generally accepted recommendation on how to best schedule home blood pressure (HBP) recordings, perhaps because the effect of varying the home monitoring schedule on the HBP average is not well studied. The goals of this analysis are to describe the effects of HBP monitoring schedules on the accuracy of resultant HBP averages and to determine which monitoring schedule parameters correlate with HBP accuracy. Twelve published studies, each including home, office, and awake ambulatory blood pressure means were identified. Accuracy of office and HBP averages were determined by their agreement with corresponding awake ambulatory averages. Variations in HBP monitoring schedule parameters did not significantly affect the accuracy of the resultant HBP averages among the studies. In univariate analyses, no individual parameter correlated significantly with the final HBP average accuracy. As the total number of HBP readings obtained increased, or as other monitoring schedule parameters intensified, the superior accuracy of HBP levels as compared to that of casual office values also failed to significantly improve. No HBP accuracy differences were found among groups characterized by different HBP schedule parameter ranges. In conclusion, the accuracy of HBP measurements, as determined by their agreement with an awake ambulatory mean, is maintained regardless of substantial variations in HBP monitoring schedules. Therefore, the majority of the benefits derived from HBP monitoring will likely be achieved by obtaining only a few HBP measurements using a minimally complex monitoring schedule.